Simultaneous lymph node biopsy and chemo port installation?

mettasun · January 2016

Just before the holidays I was diagnosed with IDC that is a very aggressive HER2+. Neoadjuvant chemo begins hopefully next week, but before chemo they want to do an USGC biopsy of a lymph node that looks suspect on MRI and US. My initial USGC breast biopsy went quite well despite my extraordinary anxiety. Now I have apprehensions about the lymph node biopsy. I am told it is not as easy.

I am wondering whether I can have the lymph node biopsy done at same time as chemo port installation, so I can take advantage of the anesthesia for both?

MelissaDallas · January 2016

I had an axial node biopsied (ultrasound guided) when I had a breast biopsy and is wasn't uncomfortable

Kicks · January 2016

Why not? A node biopsy can be a FNB (fine needle biopsy). Only need local numbing. Port implant requires (depending on your Dr) a LOT of sedation. My port was put in in OR at the hospital all, node biopsy done at the Radiology Clinic with local.

DaisyQ · January 2016

Hi Mettasun,

After I was diagnosed, I had a sentinel node biopsy and port placement in the same procedure in the OR. The node was not suspicious on the MRI, but removing the sentinel node and testing was standard protocol. It wasn't bad..and pretty quick. I remember some pain at the incision site for the SNB. There wasn't much discomfort with the port, I just had to get used to it being there. I had the procedure on a Monday morning and started TCHP chemo the next day.

If the anxiety is really bothering you, ask for a xanax prescription. It helped me through many of those early days and nights.

Let us know how it goes!

Amy

Kicks · January 2016

Forgot to mention - find out before you get to the chemo facility if tbey have numbing spray. If they don't then get a script for EMLA (or generic) numbing cream to use. It is a bit 'owie' when the needle is placed in the port if no numbing is done - spray doen't make it as numb as the cream does. My facility used numbing spray for access and it was just a slight 'pin prick'. For my flushes since end of Chemo I have used generic numbing cream and do not even feel a slight pin prick. I did have it accessed once in the hospital for the contrast for a CT and surprise - the hospital had no numbing spray so it was accessed with 'nothing' to numb and it definitely HURT big time. When/If using the cream put it on approx. an hour before infusion time so that it is working by the time you get there (exact time frame can be a bit different for different ones of us). For me it is working pretty good at 30 mins, optimunby an hour and starting to wear off a bit by 1 1/2 yrs. When putting a dab of cream over port use a small piece of 'saran wrap' over it. This holds it on the area so it works better and it protects clothes.

My port was implanted in OR on a Wed. morning and started Chemo the next day about noon - no problems.

Skittlegirl · January 2016

I had my port placed on a Monday and went the next morning to the outpatient imaging center for the lymph node biopsy.

SpecialK · January 2016

With the advent of Perjeta and its neoadjuvent use in early stage Her2+ breast cancer, this combination of SNB/lymph node biopsy with port placement should become more common. You will most likely be asleep for the port placement and so should not have any issues with the lymph node biopsy being done simultaneously. I have a good friend who had neoadjuvent chemo for triple negative breast cancer and also did this combination - her breast surgeon did the SNB and port placement, and it is a good idea to have a clear picture of lymph node status prior to starting chemo. Since chemo may eradicate cancer in the nodes it can make proper staging unclear if you wait until your breast surgery to examine the nodes.

Kathy044 · January 2016

An ultrasound guided biopsy of a suspicious lymph node is not an SNB. See initial Kicks and Melissa replies above. Perhaps the node is in an awkward location making it not as easy to do. Kathy

mettasun · January 2016

Thank you all for your input. Much appreciated!

In principle, it would seem to me that doing both a US-guided lymph node biopsy and a chemo port installation at same time makes much sense, and I am glad to hear that in some cases this is being done. However, I could not get my doctors to agree to do this.

The oncologist has experience with ports and doesn't usually do biopsies. The surgeon is willing to do the biopsy rather than send me to Radiology but perhaps feels their time is not well used installing ports, or perhaps doesn't install ports that often. Quien sabe. Bottom line is, they each want to do what they are accustomed to doing.

I could talk one doctor into doing both but decided against it. The time will hopefully come when both fairly simple procedures are routinely done at same time, and when surgeons and oncologists, or at least oncologists, have frequent experience and high proficiency in doing both--us bc folks could use that small break. But that time has not yet come, and for now, I'd rather let each doctor do what each feels they do best.

Kicks · January 2016

? - your surgeon is not implanting your port? Who is?

A port implant is a surgical process that involves not only the port body itself to be placed but also line that is fed into a vein. It's a lot more complicated than just a 'simple procedure' on the line of using a needle to access the area seen using US. Not ALL node biopsies are SNBs.

No - in my case, all of my biopsies had been done before port implant. The Radiologist at the Clinic did the biopsies (an ENT did the biopsy of an area that 'lit up' along my jaw in the PET scan the day it was done and had the path. report the next morning - 'nothing' there.

mettasun · January 2016

Kicks, apparently it's the medical oncologist that will install the port. Should I be worried? Is it usually a surgeon that does that?

SpecialK · January 2016

metta - port install is a surgical procedure that involves running tubing through the superior vena cava - usually done by an interventional radiologist, a vascular surgeon, or a breast surgeon - I have never heard of a med onc doing it - I love mine to pieces but I would never let him put in a port, this is not his area of expertise.

mettasun · January 2016

SpecialK, the clinic staff had given me incorrect info - it will indeed be an interventional radiologist, not a medical oncologist, that will install the port.

Of course the IR routinely does biopsies too, but things are not set up for one person to do both things. So, if I wanted him to do both procedures, I'd have to spend a day twisting some arms as well as cutting thru thick red tape--major surgery in and of itself. Either way some unnecessary additional stress is involved, and I hope that by raising this issue we are helping others receive more efficient care in the future.

Simultaneous lymph node biopsy and chemo port installation?

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